Children's Health

14 yr old daughter with constant headache

12/28/2006

Question:

My 14 year old daughter has a constant headache and often feels puny. She is being treated for a sinus infection, but the ENT feels a sinus infection chould not cause such extreem and constant pain. The Neurologist is waiting for the sinus infection to clear before further visits. Help?

Answer:

I am happy to hear that your daughter has been referred to a neurologist. If she has already been seen, the neurologist will have examined her carefully for signs of increased pressure in her brain associated with the worst thing all parents worry about, a brain tumor. Certainly sinus infections are a common cause of prolonged headaches, so it is a good thing that she is being treated for this potential cause of headache.

Worrisome headache findings are a headache that increases rapidly in severity, frequency, or both, a headache that is present in the morning or awakens the child during the night, and sudden vomiting without nausea preceding it, especially when going from a lying down to an upright position. If your daughter has these symptoms, recontact the neurologist now.

Tension headaches and migraine headaches are very common among teenage girls. Tendencies to have migraines runs in families. If you had them or your mother, your daughter could also have inherited the tendency to have them. They are often preceded by complaints as a younger child of chronic abdominal pain without any physical cause being identified. Migraines in children and teens do not present the same way as they do in adults. Often they are not localized to only one side of the head as they are in adults, but instead grip the entire forehead area. Auras are seldom experienced or go unrecognized. If sleep and quiet improve her headaches, migraine headache is a good possibility.

Tension headaches are really common and especially among girls as they transition into high school with the many social and scholastic demands they deal with, not to mention pressure to excell if they are on a sports team. Helping your daughter to talk about these stresses and working with her doctor or a psychologist to build her coping skills are good ways to help decrease the severity and frequency of tension headaches in addition to the frugal use of pain relievers.

The final common cause of persistent headaches is rebound headache from the excessive use of non-steroidal anti-inflammatory drugs (NSAIDs), common types being Advil, Motrin, and Aleve. Many headache sufferers make the mistake of taking high doses frequently or in combining types of drugs in an effort to gain relief. Instead, the headache worsens and is often worsened by nausea from the overdoses of the medications. This is not a good strategy, not only because of the persisting headache and nausea, but because of the potential to harm the liver and kidneys. So, if your daughter is taking lots of pain relievers, help her to stop until she sees the neurologist again.

There are also headache specialists among neurologists, so if your daughter is seeing a general neurologist, you may want to consider asking for a referral to a pediatric headache specialist. I recommend a pediatric specialist because migraines present so differently in children, a specialist primarily working with adults may not recognize the symptoms in a younger patient.

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